WASHINGTON — The sweeping legislation designed to remake the U.S. health care system also affects more narrow interests. Here are some winners and losers:
WINNERS
Libby, Mont.: Residents of this town of 2,900 suffering from asbestos-related illnesses from a now-closed mineral-mining operation now have access to Medicare benefits, thanks to a last-minute insertion by Finance Committee Chairman Max Baucus, a Montana Democrat.
Cosmetic surgeons: Fended off a 5 percent tax on procedures.
Nebraska, Louisiana, Vermont and Massachusetts: These states are getting more federal help with Medicaid than other states. In the case of Nebraska — represented by Sen. Ben Nelson, who is providing the critical 60th vote for the legislation to pass — the federal government is picking up 100 percent of the tab of a planned expansion of the program, in perpetuity. Vermont and Massachusetts get temporary increases in the federal share of their Medicaid tabs. In Louisiana, moderate Democratic Sen. Mary Landrieu negotiated $100 million for 2011 before announcing her support for the legislation.
Beneficiaries of Medicare Advantage plans — the private managed-care plans within Medicare — in Florida: Hundreds of thousands of them will have their benefits grandfathered in thanks to a provision tailored by Sen. Bill Nelson, D-Fla., that also affects a much smaller number of seniors in a few other states.
Community health centers: They got $10 billion more in the revised bill, thanks to advocacy by Sen. Bernie Sanders, I-Vt.
A handful of physician-owned hospitals being built around the country — including one in Bellevue, Neb. — that would be permitted to get referrals from the doctors who own them, avoiding a new ban in the Senate bill that will apply to hospitals built in the future. Chalk up another win for Ben Nelson.
AARP, the lobby for elderly people. The new bill has about $1 billion in extra Medicaid payments to states that provide visiting nurses and other in-home or community services to prevent low-income people from needing to be admitted to hospitals. In House-Senate bargaining, AARP also is expected to win a top priority: a full closing of the so-called “doughnut hole,” the gap in Medicare’s coverage of prescription drugs.
Doctors and hospitals in Montana, North Dakota, South Dakota, Utah and Wyoming, who will get paid more than providers elsewhere under formulas in the bill.
LOSERS
Tanning salons: The bill places a 10 percent tax on indoor tanning services, replacing the cosmetic-surgery tax.
Progressives: They had to give up on their dream of a new government-run insurance plan so Democratic leaders could lock down the necessary votes from moderates.
People making more than $200,000 a year: A proposed 0.5 percent increase in the Medicare payroll tax was bumped up to 0.9 percent in the latest version, putting the tax at 2.35 percent on income over $200,000 a year for individuals, $250,000 for couples.
Generic-drug makers: They fought unsuccessfully to block 12 years of protection that makers of brand-name biotech drugs — expensive pharmaceuticals made from living cells — will get against generic would-be competitors.
The Associated Press
